Provider Demographics
NPI:1477204683
Name:ROYAL WA SUMNER LLC
Entity type:Organization
Organization Name:ROYAL WA SUMNER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-345-5541
Mailing Address - Street 1:1590 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5957
Mailing Address - Country:US
Mailing Address - Phone:561-562-6271
Mailing Address - Fax:
Practice Address - Street 1:1723 BONNEY AVE
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-2129
Practice Address - Country:US
Practice Address - Phone:888-468-3389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder